Endoscopy 2019; 51(04): S104
DOI: 10.1055/s-0039-1681476
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: ESD stomach 2 Club A
Georg Thieme Verlag KG Stuttgart · New York

IMPLEMENTATION OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN EUROPE – SURVEY AFTER ESD EXPERT TRAINING WORKSHOPS 2009 – 2018

, , ESD WORKSHOP Training Study Group
T Oyama
1   Dept of Endoscopy, Central Hospital Advanced Care Center, Saku, Japan
,
N Yahagi
2   Div. of Research & Development for Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
,
F Berr
3   Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
,
T Kiesslich
3   Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
4   Institute of Physiology, Salzburg, Austria
,
T Ponchon
5   Hôpital Edouard Herriot, Lyon, France
,
T Toyonaga
6   Dept of Endoscopy, Kobe University Hospital, Kobe, Japan
,
T Uraoka
7   Dept of Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan
,
A Ziachehabi
8   Ordensklinikum Linz – Elisabethinen, Linz, Austria
,
F Schachinger
9   Veterinary Office, Altheim, Austria
,
H Seifert
10   Dept of Medicine, Gastroenterology, University Hospital, Oldenburg, Germany
,
G Kaehler
11   Endoscopy Div., Dept. of Surgery, Mannheim Campus, University of Heidelberg, Mannheim, Germany
,
A Wagner
3   Dept. Medicine I, Paracelsus Medical University Salzburg, Salzburg, Austria
,
H Messmann
12   Klinikum Augsburg, Augsburg, Germany
,
J Hochberger
13   Dept of Gastroenterology, Vivantes Klinikum Berlin Friedrichshain, Berlin, Germany
,
SV Kantsevoy
14   Mercy Medical Center, Univ. of Maryland School of Medicine, Baltimore, United States
,
A Mitrakov
15   Endoscopy Div., Dept. of Surgery, Nizhniy Novgorod Cancer Hospital, Nizhniy Novgorod, Russian Federation
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

    Aims:

    To obtain information on implementation of ESD in particpating centres of ten experimental ESD Training Workshops in Salzburg [Dig Endosc 2011;23:282 – 89].

    Methods:

    ESD WORKSHOPs lasted 3.3 days under instruction by international experts, 177 trainees from 135 referral centers had participated once or twice. A brief questionaire was mailed to participants of all 135 centres and reported data (n, %) analyzed.

    Results:

    Completed data from 77 of 135 centers (57%), information on zero ESD from 32 (24%), no information from 26 (19%). ESD had been implemented without supervision by expert during initial learning. Nineteen (17%) of 109 centres had performed > 150 ESD (professional level), 27 (25%) had 31 – 150 ESD (competent level), and 32 (29%) each had ≤30 ESD (initial learning) and zero ESD, resp.. Outcome (% as median, range) of centres on initial learning (n = 425 ESD) is compared to centers with > 30 ESD (n = 5439): ESD en-bloc was 75 [40 – 80]% vs. 85 [49 – 100]%, conversion to hybrid-ESD 20 [0 – 100]% vs. 11 [0 – 51]% and to piecemeal-EMR 5 [0 – 45]% vs. 4 [0 – 15]%. Majority (65 – 70%) of ESD were in colorectum (35% malignant lesions) with low risk and satisfactory oncological outcome – even during initial learning (s. table). Overall, 30 day morbidity was 0.6 ± 2.2% (stenoses), and mortality 0.04% (2 cases).

    Tab. 1:

    Outcome of implementation of ESD (median, [range])

    Percent ESD-ITT

    Colorectal ESD

    Emergency surgery

    Onco-surgery

    CA recurrence

    Initial ESD (≤30)

    65

    0 (mean 1.3)

    4

    0 (mean 0.9)

    (31 centres)

    [0 – 100]

    [0 – 11]

    [0 – 25]

    [0 – 10]

    Competent ESD (> 30

    70

    0.9 (mean 1.6)

    5

    0

    (46 centres)

    [0 – 92]

    [0 – 10]

    [0 – 18]

    [0 – 0.1]

    Conclusions:

    ESD has been implemented at least in 46 centres across Europe on competent or professional level, with low risk during unsupervised learning. The majority (65 – 70%) are colorectal ESD, even during initial learning.


    #